delegation, On the Job, Scope of Practice

Delegation from Varying Licensed Providers

Determining whether you are successfully working within your legal scope of practice as a medical assistant requires recognizing some situational nuances, especially on the matter of delegation. The following demonstrates one such instance:

I work in an outpatient practice setting. At times, I work under the authority and supervision of a physician. At other times, I work under the authority of a nurse practitioner or a physician assistant. I have been informed that my legal scope of practice is the same regardless of which licensed provider is assigning tasks to me. Is this correct?

Not necessarily. Under the laws of most states, the medical assistants’ scope of practice is determined by the practice act and regulations of the delegating provider.

For example, the nurse practice act and the regulations and policies of the state’s board of nursing determine which tasks nurses (including advanced practice registered nurses [APRNs], such as nurse practitioners) are permitted to delegate to medical assistants.

On the other hand, the medical practice act and the regulations and policies of the state’s board of medical examiners delineate which duties physicians are allowed to assign to medical assistants. And physician assistant delegation authority is established by other state statutes, regulations, and policies.

There are legal nuances that must be taken into consideration. Some states permit nurse practitioners to work autonomously and without a collaborative practice agreement with a physician. In these states the delegation authority of autonomous nurse practitioners is determined by the nurse practice act and the rules of the board of nursing.

However, nurse practitioners in an independent-practice state may choose to work under physician authority and supervision, and physicians may assign nurse practitioners to oversee medical assistants who are performing tasks delegated to them by a physician. In such a case, both the medical practice act and the nurse practice act may have a bearing on the scope of practice of a medical assistant.

4 thoughts on “Delegation from Varying Licensed Providers”

  1. Hello Mr. Balasa,

    This issue actually came up this past Friday at my place of employment here in Louisiana I will certainly check this out. In the meantime, any suggestions as Louisiana does not have legislation covering medical assistants? IF it turns out Louisiana has changes in both the Nurse Practice Act and the Physician Practice Act (which we have relied on for the MA’s scope of practice her n Louisiana) which does one follow? As far as I am aware, Louisiana does not have legislation specifically for MA’s.

    Thank you,

    Tracy Flickinger, LPN

    1. Thank you for your question. Go to http://www.aama-ntl.org and click below “State Scope of Practice Laws” on the left side of the homepage. You will be able to find the medical assisting law for Louisiana, which is found in my letter. Note the following excerpt from my letter:

      Note also the following statement from the Louisiana Board of Medical Examiners:

      Delegation March 15, 2010

      It has long been the position of the Board that the practice of medicine as defined by the Louisiana Medical Practice Act, La. Rev. Stat. §37:1262(1) may only be undertaken or performed in this state by a Louisiana licensed physician or an unlicensed individual who functions solely under a licensed physician’s direction and immediate personal supervision-i.e., where the physician is physically present in the office or suite where the procedure is being performed at all times that the unlicensed assistant is on duty (irrespective of the employee’s level of training or experience) and retains full responsibility to the patients for the training, delivery and results of all services rendered.
      An individual filling such a position could not-and may not be permitted to under any circumstances-act inde­pendently of a licensed physician or to exercise independent medical judgment in starting, selecting or imple­menting modalities of treatment. If an unlicensed person acts beyond this scope he or she would be in violation of the Louisiana Medical Practice Act. A physician enabling such activity would be in violation of the Act as well. Citations at http://www.lsbme.la.gov

      Medical assistants are considered unlicensed professionals under the Louisiana law. Therefore, the above excerpt applies to physician delegation to medical assistants.

      The extent of physician authority to delegate to unlicensed professionals such as medical assistants working under their direct/onsite supervision in outpatient settings is governed by the Louisiana Medical Practice Act and the rules and policies/positions of the LA Board of Medical Examiners, such as the above.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  2. Hello – I am in the process of starting a large multi-state telemedicine practice and would like to bring on CMAs to manage the day to day functions such as returning patient phone calls, uploading and organizing paperwork and provided education to patients. We are starting in WA, NE, and NV. The providers will all be NPs. The providers, patients, and CMAs will all be in their own homes. Are we able to use CMAs for this or do we need to bring on LPNs instead? Thank you!

    1. Thank you for your question. Go to http://www.aama-ntl.org and click below “State Scope of Practice Laws” on the left side of the homepage. You will be able to find the medical assisting law of all states.

      I do not have expertise in the telemedicine laws of the states. Therefore, I am not able to offer an opinion about the nurse practitioners are and are not permitted to do in a telehealth environment. However, I am able to state that it is my legal opinion that—assuming that there are no laws in Nevada, Nebraska, and Washington that limit nurse practitioner telehealth practice and delegation—NPs are permitted to delegate to knowledgeable and competent unlicensed professionals such as medical assistants the returning of patient phone calls, the downloading and organizing of paperwork, and patient education as long as these tasks do not require the medical assistant to exercise any independent clinical judgment or the making of any clinical assessments or evaluations. The phone calls must be limited to verbatim conveying of information authorized by the delegating NP, and the verbatim receipt of information from patients for the NPs consideration.

      I will send you one of my documents that explains this legal principles in greater detail.

      I hope this proves to be helpful.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

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